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Question

A 4&1/2 year old girl born to consangious(2 degree) parents presented with, seizures( staring look & unresponsiveness) at the age of 2 years, was put on gardinal (but seizures recurred shifted to eptoin 3 months back.). 6 months later (at the age of 2&1/2 years), child started having episodes of vomiting nonbilious & non projectile,15-20 per dayl. each episode lasting for 10-12 days , for every 3-4 months ,initially later every 1-2 months. ass with loss of appetite and weight. development normal. h/o death of elder sister at the age of 3 years with c/o vomiting, &suspected liver disease (reports n a) o/e----poorly built and nourished vitals--- hr 110 / min. bp 124/90 (hypertension) rr 26/min. hepatomegaly (mild) no spleen. othes systems normal. investigations.----- cbp--- hb 10 tlc-- 5600/cumm plt -- adequate. rft---normal. abg--- normal.uppar gi endoscopy --- mild esophagitis.barium meal f/t normal, montoux -- negative. usg abd --- mild hepatomegaly. csf --normal. ct---normal. sr ammonia, pyruvate -- normal. lactate--- elevated(twice upper limit) urinary vma and urinary protoporphyrinogen negative. please suggest further investigations,dd and management.

Answer

Rule out pancreatitis. Also do H.pylori stool test. The CT is of the brain or the abdomen? If not done brain CT, rule out brain tumor. Also do blood gases to rule out metabolic acidosis and barters syndrome.
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